LEARNING OBJECTIVE: Evaluate the needs of a surgical patient during the preoperative, operative, recovery, and postoperative phases of his treatment.

Surgical procedures are classified into two major categories: emergency and elective. Emergency surgery is that required immediately to save a life or maintain a necessary function. Elective surgery is that which, in most cases, needs to be done but can be scheduled at a time beneficial to both the patient and the provider. Regardless of the type of surgery, every surgical patient requires specialized care at each of four phases. These phases are classified as preoperative, operative, recovery, and postoperative. The following discussion will address the basic concepts of care in each phase.

Preoperative Phase
Before undergoing a surgical procedure, the patient must be in the best possible psychological, spiritual, and physical condition. Psychological preparation begins the moment the patient learns of the necessity of the operation. The physician is responsible for explaining the surgical procedure to the patient, including the events that can be expected after the procedure. Since other staff personnel reinforce the physician's explanation, all members of the team must know what the physician has told the patient. In this manner, they are better able to answer the patient's questions. All patients approaching surgery are fearful and anxious. The staff can assist in reducing this fear by instilling confidence in the patient regarding the competence of those providing care. The patient should be given the opportunity and freedom to express any feelings or fears concerning the proposed procedure. Even in an emergency, it is possible to give a patient and the family psychological support. Often this is accomplished simply by the confident and skillful manner in which the administrative and physical preoperative preparation is performed.

The fears of presurgical patients derive from their insecurities in the areas of anesthesia, body disfigurement, pain, and even death. Frequently, religious faith is a source of strength and courage for these patients. If a patient expresses a desire to see a clergyman, every attempt should be made to arrange a visit.

ADMINISTRATIVE PREPARATION.- Except in emergencies, the administrative preparation usually begins before surgery. A step-by-step procedure is outlined in Fundamental Skills and Concepts in Patient Care, "Caring for the Patient Undergoing Surgery." Only the Request for Administration of Anesthesia and for Performance of Operations and Other Procedures (SF 522) will be addressed here. The SF 522 identifies the operation or procedure to be performed; has a statement written for the patient indicating in lay terms a description of the procedure; and includes the signatures of the physician, patient, and a staff member who serves as a witness. An SF 522 must be completed before any preoperative medications are administered. If the patient is not capable of signing the document, a parent, legal guardian, or spouse may sign it. It is customary to require the signature of a parent or legal guardian if the patient is under 21 years of age, unless the patient is married or a member of the Armed Forces. In these latter two cases, the patient may sign his own permit, regardless of age.

Normally, the physical preparation of the patient begins in the late afternoon or early evening the day before surgery. As with the administrative preparation, each step is clearly outlined in Fundamental Skills and Concepts in Patient Care, "Caring for the Patient Undergoing Surgery."